Osteoid osteoma: the great mimicker

AbstractOsteoid osteoma is a painful, benign and common bone tumor that is prevalent in young adults. The typical clinical presentation consists of pain that becomes worse at night and is relieved by nonsteroidal anti-inflammatory drugs. The most common imaging finding is a lytic lesion, known as a nidus, with variable intralesional mineralization, accompanied by bone sclerosis, cortical thickening and surrounding bone marrow edema, as well as marked enhancement with intravenous contrast injection. When the lesion is located in typical locations (intracortical bone and the diaphyses of long bones), both characteristic clinical and radiological features are diagnostic. However, osteoid osteoma is a multifaceted pathology that can have unusual presentations, such as intraarticular osteoid osteoma, epiphyseal location, lesions at the extremities and multicentric nidi, and frequently present atypical clinical and radiological manifestations. In addition, many conditions may mimic osteoid osteoma and vice versa, leading to misdiagnosis. Therefore, it is essential to understand these musculoskeletal diseases and their imaging findings to increase diagnostic accuracy, enable early treatment and prevent poor prognosis.

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Osteoid Osteoma at the Proximal Diaphysis of the Fifth Metatarsal

Journal of the American Podiatric Medical Association ◽

10.7547/15-059 ◽

2017 ◽

Vol 107 (4) ◽

pp. 342-346 ◽

Cited By ~ 1

Author(s):

Muhammet Baybars Ataoglu ◽

Ali Kh. Ali ◽

Mustafa Ozer ◽

Hüseyin Nevzat Topcu ◽

Mehmet Cetinkaya ◽

...

Keyword(s):

Osteoid Osteoma ◽

Trauma Surgery ◽

Lytic Lesion ◽

Cortical Thickening ◽

Resonance Imaging ◽

Lateral Aspect ◽

Plain Radiographs ◽

Atypical Symptoms ◽

History Of ◽

Inflammatory Drugs

The foot is rarely the focus of osteoid osteoma, and only a few of those cases are related to the fifth metatarsal. The present case demonstrates that atypical symptoms with suspicious findings on plain radiographs that are not associated with trauma must be analyzed carefully to determine the nature of the lesion and perform the precise treatment to obtain and sustain the cure. A 29-year-old man presented to the outpatient clinic with a 2-year history of chronic pain in the lateral aspect of his left forefoot. The onset was not related to trauma, surgery, local infection, osteomyelitis, or another entity regarding the proximal fifth metatarsal. The patient noted that the pain was aggravated at night and typically subsided with the use of salicylates or other nonsteroidal anti-inflammatory drugs. Initial plain radiographs demonstrated cortical thickening and a lytic lesion at the proximal diaphysis of the fifth metatarsal. Because the pain relief was transient, we suspected an osteoid osteoma lesion, and subsequent magnetic resonance imaging manifested pathognomonic signs of subperiosteal osteoid osteoma. Diagnosis was followed by planning of the surgery that ended the patient's symptoms.

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Detection of Bone Marrow Edema in Patients with Osteoid Osteoma Using Three-Material Decomposition with Dual-Layer Spectral CT

Diagnostics ◽

10.3390/diagnostics11060953 ◽

2021 ◽

Vol 11 (6) ◽

pp. 953

Author(s):

Florian T. Gassert ◽

Johannes Hammel ◽

Felix C. Hofmann ◽

Jan Neumann ◽

Claudio E. von Schacky ◽

...

Keyword(s):

Bone Marrow ◽

Osteoid Osteoma ◽

Bone Marrow Edema ◽

Volume Fraction ◽

Imaging Findings ◽

Spectral Ct ◽

Material Decomposition ◽

Negative Imaging ◽

Interreader Agreement ◽

Marrow Edema

The aim of this study is to assess whether perifocal bone marrow edema (BME) in patients with osteoid osteoma (OO) can be accurately detected on dual-layer spectral CT (DLCT) with three-material decomposition. To that end, 18 patients with OO (25.33 ± 12.44 years; 7 females) were pairwise-matched with 18 patients (26.72 ± 9.65 years; 9 females) admitted for suspected pathologies other than OO in the same anatomic location but negative imaging findings. All patients were examined with DLCT and MRI. DLCT data was decomposed into hydroxyapatite and water- and fat-equivalent volume fraction maps. Two radiologists assessed DLCT-based volume fraction maps for the presence of perifocal BME, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). Accuracy, sensitivity, and specificity for the detection of BME on DLCT were analyzed using MR findings as standard of reference. For the detection of BME in patients with OO, DLCT showed a sensitivity of 0.92, a specificity of 0.94, and an accuracy of 0.92 for both radiologists. Interreader agreement for the assessment of BME with DLCT was substantial (weighted κ = 0.78; 95% CI, 0.59, 0.94). DLCT with material-specific volume fraction maps allowed accurate detection of BME in patients with OO. This may spare patients additional examinations and facilitate the diagnosis of OO.

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Treating Superficial Venous Thrombophlebitis

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2008.0057 ◽

2008 ◽

Vol 6 (8) ◽

pp. 760-765 ◽

Cited By ~ 10

Author(s):

Jason T. Lee ◽

Maziyar A. Kalani

Keyword(s):

Clinical Presentation ◽

Low Molecular Weight ◽

Superficial Vein ◽

Low Molecular Weight Heparins ◽

Surgical Interventions ◽

Superficial Thrombophlebitis ◽

Compression Bandages ◽

Elastic Stockings ◽

Inflammatory Drugs ◽

Valvular Insufficiency

Superficial venous thrombophlebitis (SVT) is characterized as a localized inflammatory condition of the venous vessels underlying the skin. It arises from thrombosis of a superficial vein, and clinical presentation usually involves pain, erythema, and tenderness at the sites of inflammation. Although the condition is usually self-limited and not serious or fatal, symptomatic superficial thrombophlebitis can be debilitating, limit movement and certain capabilities, or progress to involve the deep venous system and cause pulmonary embolism. SVT is typically associated with venous valvular insufficiency, pregnancy, infection, and prothrombotic conditions, including malignancy. Currently, medical therapies comprising bedrest, elastic stockings, compression bandages, nonsteroidal anti-inflammatory drugs, and low molecular weight heparins are used to reduce the extension of inflammation and recurrence of thrombotic events in patients experiencing SVT. In patients refractory to conservative measures, surgical interventions such as phlebectomy, sclerotherapy, saphenous junction ligation, or saphenous vein stripping are potential treatments.

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Acute calcific periarthritis secondary to calcium hydroxyapatite crystal deposition in the wrist: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa524 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Joseph A Walker ◽

Elizabeth R McLean ◽

Raymond E Anakwe

Keyword(s):

Case Report ◽

Clinical Presentation ◽

Diagnostic Procedures ◽

Calcium Hydroxyapatite ◽

Wrist Pain ◽

Crystal Deposition ◽

Joint Aspiration ◽

Hydroxyapatite Crystal ◽

Inflammatory Drugs ◽

Calcific Periarthritis

ABSTRACT Acute calcific periarthritis (ACP) is an unusual cause of monoarticular pain characterised by the deposition of calcium hydroxyapatite in the peri-articular and intra-articular tissues. Although the most commonly affected joint is the shoulder, other joints may be involved, including the wrist. This case report describes a 57-year-old female presenting with wrist pain and swelling associated with amorphous calcification overlying the lunate. The patient improved with the use of non-steroidal anti-inflammatory drugs and splinting. Clinician awareness of the clinical presentation and radiographic features of ACP is important to reduce unnecessary invasive diagnostic procedures such as joint aspiration.

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Osteoid Osteoma of Cuboid Bone- A Rare Cause of Chronic Foot Pain in Childhood –A Case Report

Asian Journal of Medical Research ◽

10.47009/ajmr.2020.9.4.or1 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1-4

Author(s):

Sunny Chaudhary ◽

V Abdusamad ◽

Aman Verma ◽

Varun Garg ◽

R K Siddharth ◽

...

Keyword(s):

Osteoid Osteoma ◽

Blood Parameters ◽

Age Group ◽

Benign Bone Tumor ◽

Foot Pain ◽

Good Clinical Outcome ◽

Foot Bones ◽

Pediatric Age Group ◽

Cuboid Bone ◽

Inflammatory Drugs

Chronic foot pain in pediatric age group is less common. The usual differential diagnosis may vary from musculoskeletal injury to serious diseases such as osteomyelitis. Benign bone tumor such as osteoid osteoma of foot is exceedingly rare in this age group. Here we present a rare case of osteoid osteoma of cuboid mimicking osteomyelitis. Patient was managed conservatively by Non-steroidal Anti-inflammatory drugs (NSAIDs) with good clinical outcome. Osteoid osteoma of foot bones should be kept in mind in cases with normal blood parameters.

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Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis

Case Reports in Rheumatology ◽

10.1155/2020/8810735 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Hend Abd El Baky ◽

Richard D. Thomas ◽

Joseph Kuechle ◽

Rabheh Abdul-Aziz

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Ct Scan ◽

Osteoid Osteoma ◽

Complete Blood Count ◽

External Rotation ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Hip Pain ◽

Intravenous Contrast ◽

Ct Guided ◽

Multifocal Osteomyelitis

Osteoid osteoma (OO) is a benign bone tumor that usually presents between 10 and 35 years of age. The metaphysis and diaphysis of the femur and tibia are the typical locations. The diagnosis is usually straightforward when images reveal a radiolucent nidus surrounded by reactive sclerosis. However, the diagnosis is more difficult when it occurs at atypical locations with nonspecific and misleading appearance on images. OO may mimic juvenile idiopathic arthritis (JIA), bone infection, or malignancy. We present a 14-year-old male with a 4-month history of left hip pain. His pain was worse with playing hockey and lacrosse and in the morning and sometimes woke him up at night. His examination was significant for pain with flexion and external rotation of the left hip and for mild limitation of full external rotation. Blood work revealed normal complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Left hip X-ray was unremarkable. Left hip MR arthrogram showed marked edema of the medial and posterior walls of the left acetabulum. CT-guided biopsy of the left acetabulum showed unremarkable flow cytometry and chronic inflammatory component raising concern about chronic recurrent multifocal osteomyelitis (CRMO). Bone scan revealed focal increased uptake in the left acetabulum and no additional abnormality. Repeat MRI with intravenous contrast showed a left hip effusion, focal synovial enhancement in the medial left hip, and acetabula edema. The patient failed treatment for presumed JIA and CRMO with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate, and adalimumab. CT scan of the left hip was performed for further evaluation of the bone and showed 11 × 6 mm low attenuation focus with subtle internal nidus in the posteromedial aspect of the acetabular rim, suggestive of intra-articular OO. Radiofrequency ablation was performed with no complications, and the left hip pain improved. The atypical location resulted in delay of diagnosis for 12 months after presentation. We highlight the diagnostic pitfalls observed in atypical OO locations and the difficulties this creates with making the diagnosis. OO mimicking JIA has previously been described. We submit CRMO as another differential diagnosis which may be mimicked and demonstrate the vital role of CT scan in the diagnosis.

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Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis

Journal of Neurosurgery Spine ◽

10.3171/2011.8.spine1142 ◽

2011 ◽

Vol 15 (6) ◽

pp. 636-640 ◽

Cited By ~ 3

Author(s):

Keerthiraj Bele ◽

Hima Shriniwas Pendharkar ◽

Easwer Venkat ◽

Arun Kumar Gupta

Keyword(s):

Ankylosing Spondylitis ◽

Cauda Equina Syndrome ◽

Imaging Finding ◽

Cauda Equina ◽

Lytic Lesion ◽

Unique Case ◽

Posterior Aspect ◽

Rare Finding ◽

Dural Ectasia ◽

Vertebral Bodies

Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

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Subacute Thyroiditis: Clinical Presentation and Long Term Outcome

International Journal of Endocrinology ◽

10.1155/2014/794943 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Assim A. Alfadda ◽

Reem M. Sallam ◽

Ghadi E. Elawad ◽

Hisham AlDhukair ◽

Mossaed M. Alyahya

Keyword(s):

Clinical Presentation ◽

Thyroid Stimulating Hormone ◽

Subacute Thyroiditis ◽

University Hospital ◽

Term Outcome ◽

Long Term Outcome ◽

Thyroid Uptake ◽

Inflammatory Drugs ◽

And Gender

Few studies have been reported from the Kingdom of Saudi Arabia (SA) to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT). Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded.β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted.

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Intra-Articular Osteoid Osteoma as a Cause of Anteromedial Knee Pain

Case Reports in Orthopedics ◽

10.1155/2017/5846368 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Ergin Sagtas ◽

Kemal Gokkus ◽

Ahmet Turan Aydin

Keyword(s):

Knee Pain ◽

Osteoid Osteoma ◽

Bone Marrow Edema ◽

Correct Diagnosis ◽

Multislice Ct ◽

Treatment Method ◽

Left Knee ◽

X Rays ◽

Mri Findings ◽

Sclerotic Lesions

A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs) was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method.

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Impact of Anti-Inflammatory Drugs on Pyogenic Vertebral Osteomyelitis: A Prospective Cohort Study

International Journal of Rheumatology ◽

10.1155/2016/9345467 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Aurélien Dinh ◽

Maxime Jean ◽

Frédérique Bouchand ◽

Benjamin Davido ◽

Alexis Descatha ◽

...

Keyword(s):

Clinical Presentation ◽

Diagnostic Delay ◽

Vertebral Osteomyelitis ◽

Diagnosis Delay ◽

Cure Rate ◽

Pyogenic Vertebral Osteomyelitis ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

A Prospective Study ◽

The Impact

Objective. Pyogenic vertebral osteomyelitis (PVO) are frequently misdiagnosed and patients often receive anti-inflammatory drugs for their back pain. We studied the impact of these medications. Methods. We performed a prospective study enrolling patients with PVO and categorized them depending on their drugs intake. Then, we compared diagnosis delay, clinical presentation at hospitalization, incidence of complications, and cure rate. Results. In total, 79 patients were included. Multivariate analysis found no correlation between anti-inflammatory drug intake and diagnosis delay, clinical presentation, complications, or outcome. Conclusion. Anti-inflammatory drugs intake does not affect diagnostic delay, severity at diagnosis, or complications of PVO.

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